It is also possible for those who did not suffer from acne in their adolescence to struggle with acne issues during pregnancy. If the client had acne with her first pregnancy, most likely she will develop acne with subsequent pregnancies.
Acne during pregnancy is due to the body’s increase in both male and female sex hormone levels. Both men and women produce, in different percentages, hormones called androgens. In women, androgens are produced in the ovaries, adrenal glands, and the fat cells, which are converted into estrogen and progesterone. Hormones start circulating in the female body during puberty and play an important role in the acne seen in teenagers. Androgen levels fluctuate throughout life and are known to overstimulate the sebaceous glands, correlating to the severity of acne problems. Androgens are important in the role of reproduction. During the first trimester of a pregnancy, there is a dramatic increase in estrogen and progesterone levels, which is necessary to support the development of the baby. The rapid acceleration of these hormones causes body changes including acne, melasma, and nausea.

Contraindications During Pregnancy
Due to an increase of natural oils from rising hormones during pregnancy, excess sebum is produced. Skin cells that have been shed combine with the excess sebum and accumulate in the hair follicles. This becomes the perfect environment for bacterium and results in acne. Acne treatments while pregnant are limited due to the potential adverse effects on the fetus. One of the most effective treatments for severe acne, isotretinoin (vitamin A derivative), has been assigned by the Food & Drug Administration (FDA) to pregnancy category X due to the causation of severe birth defects. The following drugs are contraindicated for a pregnant woman and have strict regulations to insure that a pregnancy does not occur during their use: absorica, amsteem, claravis, myorisan, and sotret. As there has been no documentation on the safety of topical retinoids during pregnancy, it is best to avoid their use. These would include any topical product that contains vitamin A palmitate, vitamin A propionate, or retinoic acid. Oral antibiotics in the tetracycline classification, doxycyline, minocycline, and tetracycline, commonly used in the treatment of acne, are also not safe to use when pregnant as they affect bone growth and tooth color in the fetus.

Psychological Effects of Acne
Acne during pregnancy can have deep psychological effects. Many pregnant clients expect to have a pregnancy glow, but instead find themselves dealing with acne. This can cause clients to feel self-conscious, become depressed, or suffer from anxiety as their self-image and self-esteem are lowered. Some women even begin to withdraw from social encounters or have less confidence in their relationships.

The Role of the Skin Care Professional
Even though treatment options are limited, there are many ways to help a pregnant client reduce or limit the effects of acne and maintain healthy skin. Skin care professionals can have a large impact on a woman during pregnancy by helping her feel better about her skin. Professionals should learn how to advise and educate the expectant client on proper skin care during this special time in her life. Educating her about comedogenic products is a good place to start as the professional may need to change some of the products the client is currently using, eliminating products that contain retinoids and replacing them with an alpha hydroxy acid or a benzoyl peroxide regimen.

Topical Acne Treatments
Using topical acne treatments is a way to help control pregnancy breakouts. As little as five to 10 percent of the ingredients in topical acne products are absorbed through the skin. With such a low amount passing into the body, little to no medication would reach the developing fetus. If some of the medication were to reach the fetus, it would be such a low dosage that it would be unlikely to cause birth defects.
The topical alpha hydroxy, lactic, glycolic, and mandelic acids are safe and effective in the treatment of acne in pregnant clients. Mandelic acid, derived from the hydrolysis of bitter almonds, has a longer carbon chain than lactic or glycolic. Therefore, depending on the percentage, there is less erythema and visible exfoliation. This mild alpha hydroxy acid is antibacterial and, when used topically on a daily basis, prevents the slugging up of the dead cells in the follicle, thereby decreasing the severity of acne.
Every woman’s body handles the stressors of pregnancy differently. By having a skin care professional by their side to address their specific skin type and issues, she will keep that pregnancy glow.

Other Tips
Sunscreen should remain an important part of skin care during pregnancy
as it helps to protect against sun-induced melasma. The physical sunscreens, such as those with titanium dioxide and zinc oxide, do not penetrate the skin, making them the best choice for a pregnant woman. It is also advised that pregnant clients should avoid sunscreens that contain oxybenzone.
The beta hydroxy acid, salicylic acid, used in face and body peels is not recommended for pregnant women.
Soy-based lotions and facial products have an estrogenic effect that can make acne and melasma worse. Look for active soy products which have had the estrogenic components removed.
Refined carbohydrates such as sugar, flour, white potatoes, and those found in some cereal products induce acne. Once these carbohydrates are digested, they are absorbed into the bloodstream and cause insulin levels to surge. High insulin levels increase acne development because they promote inflammation, an overgrowth of skin cells, and raise androgen levels. Pregnant clients should try to avoid refined carbohydrates.